Occupational therapy (therapeutic activities)
Facility: Bluffton Regional Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $73
- Cash Discount Price: $75
- vs. Medicare Baseline: 2.08x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $35.07 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 208% of the Medicare baseline (a markup of 108%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Amish Aid | $21 - $101 | 60% |
| Self Pay | $21 - $232 | 60% |
| Physicians Health Plan | $22 - $56 | 63% |
| Theramatrix | $24 | 68% |
| Lutheran Preferred Network | $27 - $338 | 77% |
| Cigna | $28 - $149 | 80% |
| Php | $28 - $55 | 80% |
| Php Freedom Network | $28 - $67 | 80% |
| UnitedHealthcare | $30 - $208 | 86% |
| Tricare | $31 | 88% |
| Aetna | $32 - $188 | 91% |
| Blue Cross Blue Shield | $33 - $186 | 94% |
| Department Of Veterans Affairs | $33 | 94% |
| Humana | $33 - $186 | 94% |
| Medicare (plans) | $33 | 94% |
| Node Caresource Mcr Adv | $33 | 94% |
| Node Iu Health Mcr Adv | $33 | 94% |
| Node Mhs Mcr Adv | $33 | 94% |
| Node Non Par Hospice Agree | $33 | 94% |
| Node Va | $33 | 94% |
| Northeast Hospice | $33 | 94% |
| Veterans Eval Services | $33 | 94% |
| Node Devoted Health Mcr Adv | $34 | 97% |
| Php Management Systems | $34 - $163 | 97% |
| County Jail Health Care | $35 | 100% |
| In Dept Of Correction | $35 | 100% |
| Node Pphp Mcr Adv | $35 | 100% |
| Lutheran Trma | $36 - $190 | 103% |
| Encore Ppo | $44 - $206 | 125% |
| Sagamore Sebt | $45 - $216 | 128% |
| Sagamore Health Newtork Inc | $48 - $226 | 137% |
| Align Networks | $50 - $295 | 143% |
| Lutheran Advanced Network | $50 | 143% |
| Lutheran Three Rivers Preferred Plus 150 | $50 | 143% |
| Us Department Of Labor | $54 | 154% |
| Consumer Life | $55 - $262 | 157% |
| Ahg Dana Employees | $58 - $274 | 165% |
| Lutheran Three Rivers Preferred Plus 175 | $59 | 168% |
| Encore Work Comp In | $60 | 171% |
| Prime Health Services | $60 - $316 | 171% |
| Medrisk In Work Comp | $65 | 185% |
| Lutheran Northwest Health Preferred | $67 | 191% |
| Managed Health Services Exchange | $67 | 191% |
| Private Healthcare Systems Inc | $67 - $316 | 191% |
| Workers Compensation | $67 | 191% |
| Multiplan | $71 - $338 | 202% |
| Encore Health Network | $73 - $380 | 208% |
| Advantage 360 | $74 - $350 | 211% |
| Community Health Alliance | $76 - $359 | 217% |
| First Health | $77 - $363 | 220% |
| Allied Benefit Systems | $80 - $380 | 228% |
| Cardinal Health Alliance | $80 - $380 | 228% |
| Encore Kba Epo | $80 | 228% |
| Ppom | $80 - $380 | 228% |
| Encore Kba Ppo | $100 | 285% |
| Caresource | $186 | 530% |
| Medicaid / KanCare | $186 | 530% |
| Mhs | $186 | 530% |
| Mhs In Hip | $186 | 530% |